HEALTH TRAIN EXPRESS
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.

Monday, January 30, 2017

The line between pharma and health information technology is blurring. SAAD (Software ad a drug stands alongside . of SAAS (Software as a Service)

The progress is punctuated by the FDA which will require vetting of health software when it is linked to treatments. No such requirement has been proposed for electronic health records, but is now being required for mobile health applications and/or remote monitoring.

In the past the FDA (Food and Drug Administration) was responsible for the safety of food stuffs. It is also responsible for the safety and efficacy of pharmaceuticals, and medical devices. The vetting of pharmaceuticals is complex and very expensive. The cost of new drug development is quoted as between 450 million dollars and 900 million dollars. Pharma uses these figures to justify the cost of new proprietary formulations. The patents are valid for 16 years. When a new drug makes the 16 year mark it becomes available to other pharmaceutical companies to be sold as generic drugs, and the cost drops significantly.

Thursday, January 26, 2017

Conducted in December and January and published online Wednesday in the New England Journal of Medicine, the new survey shows that nearly three-quarters of general practitioners favored making changes to the Obama administration’s signature healthcare reform measure.

But in this nationally representative sample of primary care doctors, only 15% favored the law’s repeal. Among responding physicians who voted for Donald Trump, only 38% favored the law’s repeal.

That makes the repeal of the Affordable Care Ac, also known as Obamacare, far less popular among the physicians on the front lines of medicine than it is in the American body politic. A Kaiser Family Foundation poll taken after the November 2016 election found that 26% of Americans wanted to see Obamacare repealed.

Among the survey’s most striking findings was strong support for an extension of the Affordable Care Act that is absent from any GOP proposals: Two-thirds of primary care physicians endorsed the idea that any healthcare reform should include a public insurance option resembling Medicare that would compete with private plans.

Study coauthor Dr. Craig Evan Pollack, an internal medicine specialist at Johns Hopkins University School of Medicine, said he was struck by the strength of physicians’ opposition to measures that increased complexity and shifted costs toward patients. He suggested it was a direct result of doctors’ experience in caring for patients.

“As physicians, we see people struggle with out-of-pocket costs, deciding which types of care they’re able to afford and making very challenging decisions,” said Pollack. Primary care physicians, he added, “try to advocate for their patients.”

The new survey reflects the answers of 426 physicians drawn from a master file of the American Medical Assn. and is considered a nationally representative sample. Its findings appear to mark a significant shift in physicians’ opinions about the Affordable Care Act. In the opening months of 2015, 48% of primary care physicians had a favorable opinion of the Affordable Care Act and 52% viewed it unfavorably.

Dr. David Grande, an internal medicine physician at the University of Pennsylvania’s Perelman School of Medicine, said that as the Affordable Care Act got up and running, virtually all of his colleagues have treated new patients who had previously been uninsured or who struggled to hold on to insurance.

All of this research data contains medical studies and biologic studies. It also contains the development of sensors for remote monitoring of vital signs, blood glucose monitoring. It is a treasure chest of data.

NASA just announced that any published research funded by the space agency will now be available at no cost, launching a new public web portal that anybody can access.

The free online archive comes in response to a new NASA policy, which requires that any NASA-funded research articles in peer-reviewed journals be publicly accessible within one year of publication.

Right now, there are some 861 research articles in the database, and you can expect that number to keep rising as NASA-funded researchers get on board with the new policy.

But not all NASA-funded research can be found in the archive. As the space agency indicates, patents and material governed by personal privacy, proprietary, or security laws are exempt from having to be included in PubSpace.

Tuesday, January 24, 2017

All of us are aware of the cross over between technology and medicine. Often these developments are fueled by young engineers who decide to become physicians, or biomedical engineers.

It doesn't seem unreasonable that the smartphone in your pocket could be used for medical applications, education, remote monitoring, reminders, and access to your personal health information.

The list of 'mobile apps' grows daily. A search on Googe for Smartphone Medical Apps yields over 800,000 results. Some of them are duplicated, however the number of search returns is quite impressive.

Someone posits the market value generously. There are several caveats.

1. Buyers are not always consistent users. Studies reveal that purchasers often are curious and evaluate the application, but do not continue to use it for it's intended purpose, for one reason or another.

2. Reality often does not meet consumer expectation.

3. Treatments based upon the mobile app are dangerous unless the device and software are vetted by the FDA. Some apps are considered medical devices and must be approved for an IDE(Investigative Device Exemption prior to commercial marketing

The following are key features from the Wills Eye Glaucoma app:

Educational videos about glaucoma, how to use eye drops, benefits of glaucoma laser treatment, and surgery

Aetna Inc.’s $37 billion deal to buy rival insurer Humana Inc. was blocked by a federal judge, thwarting one of two large mergers that would reshape the U.S. health-care landscape. Aetna said it was considering an appeal.

The transaction would violate antitrust laws by reducing competition among insurers, U.S. District Judge John D. Bates in Washington ruled on Monday. With the deal defeated, Aetna owes Humana a $1 billion breakup fee under the terms of the merger agreement.

“We’re reviewing the opinion now and giving serious to consideration to an appeal after putting forward a compelling case,” T.J. Crawford, an Aetna spokesman, said. A Humana spokesman didn’t immediately respond to a request for comment.The government case against the merger focused on the market for private health plans for the elderly, known as Medicare Advantage. The U.S. argued the Aetna-Humana deal would have eliminated competition between the insurers in 364 counties in 21 states and likely forced seniors to pay higher premiums for Medicare Advantage plans. It also threatened competition on the insurance exchanges set up under Obamacare, the Justice Department said.

Aetna countered that the Medicare market is much larger than the Justice Department claims because it includes both Medicare Advantage plans and original Medicare, providing more choice for seniors than the government portrayed. Competition on the exchanges isn’t an issue, they said, because Aetna withdrew from all 17 counties at issue in the government’s case.

The judge sided with the government’s view of the Medicare Advantage market. “In that market, which is the primary focus of this case, the merger is presumptively unlawful—a conclusion that is strongly supported by direct evidence of head-to head competition as well. The companies’ rebuttal arguments are not persuasive,” Bates wrote.

Judge John B. Bates ruled the "proffered efficiencies do not offset the anticompetitive effects of the merger." A finalized deal would "substantially lessen" competition in the Medicare Advantage market and public exchanges, the federal judge concluded.from BloombergThe government case against the merger focused on the market for private health plans for the elderly, known as Medicare Advantage. The U.S. argued the Aetna-Humana deal would have eliminated competition between the insurers in 364 counties in 21 states and likely forced seniors to pay higher premiums for Medicare Advantage plans. It also threatened competition on the insurance exchanges set up under Obamacare, the Justice Department said.Aetna countered that the Medicare market is much larger than the Justice Department claims because it includes both Medicare Advantage plans and original Medicare, providing more choice for seniors than the government portrayed. Competition on the exchanges isn’t an issue, they said, because Aetna withdrew from all 17 counties at issue in the government’s case.

The judge sided with the government’s view of the Medicare Advantage market. “In that market, which is the primary focus of this case, the merger is presumptively unlawful—a conclusion that is strongly supported by direct evidence of head-to head competition as well. The companies’ rebuttal arguments are not persuasive,” Bates wrote.

Commentary (author)

Medicare Advantage plans are not true Medicare (original) plans. They are contracted entities of private insurers. Medicare Advantage plans represent a growing penetration of the overall Medicare market. These advantage plans are contracted and paid by Medicare. They offer their own risk management, quality assurance, and a relatively closed provider network.

The penetration rate varies widely from state to state, county to county, and rural vs metropolitan regions. The Kaiser Foundation offers specific figures on Advantage Plan penetration.

Saturday, January 21, 2017

The details of the Affordable Care Act are lost in translation. This post details the major problems with the provider-CMS insurance bureaucracy. It is also the major reason for most physician burnout. Whether or not the Affordable Care Act is repealed this is one of the major problems for any revised system.

To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In healthcare, incompetence can be found in odd places, such as three recent examples encountered with third party payers.

Case 1: Downgrading Caviar to Boiled Salmon

A patient was referred for a CT angiogram run off – which is a CT scan of the arteries of the belly, pelvis, both legs and feet – a very detailed and costly study. The cardiologist suspected a pseudo-aneurysm of the femoral artery. The exam was an overkill, I felt, as the femoral arteries could be covered in a CT angiogram of the abdomen and pelvis – you don’t need to image down to the toes. I was confident that a pseudo-aneurysm in the femoral artery would not extend to the arteries of the feet – it would be a world record, if it did. I suggested we stop the exam in the middle of the thigh. “That’s fraud,” warned the chief technologist, who was also an expert in billing.

“Why is it fraud to restrict the field of view to the area of clinical relevance?” I asked.

“You can’t bill for a CT angiogram run off and only do the abdomen and pelvis. That’s fraud.”

“Why don’t we bill just for CT angiogram of the abdomen and pelvis?” I asked.

“You can’t bill just for the abdomen and pelvis, the patient has been pre-authorized for a run off.”

“You mean I can’t do less and bill for less when the patient has been pre-authorized for more and the insurer will pay more?” I asked.

Case 2: Cutting your nose to spite your face

A young man had a cardiac MRI for palpitations. During the exam I spotted a hole in the heart – a left-to-right shunt. It was an incidental finding. I thought we should get flow measurements through the aorta and pulmonary artery – it would be useful information which could help the management, because the timing of repair of shunts depends on these parameters.

“Can’t do flows. He hasn’t been pre-authorized for them,” said the tech.

“Just do it. Don’t bill – I’ll take the flak,” I offered.

“Can’t, we’re forbidden to do more than has been ordered,” the tech protested.The referring cardiologist agreed and put an order for flow mapping. However, the order needed authorization from insurers. I phoned the insurer who connected me to a physician from the advanced imaging management elite squad – also known as radiology benefit managers. The chap, a most boring metronome, told me that the first line test for left-to- right shunt was an echocardiogram. I explained that the patient, a young professional with a demanding job, would have to take another day off work – we could easily nip the issue in the bud within five minutes. But the chap continued like a broken down record, “Our guidelines say echocardiogram first.”

I slammed the phone and muttered “ducking tosser” under my breath.The patient came back another day for an echocardiogram and another day for another cardiac MRI for flow measurements because the echocardiogram was not clear enough. Imagine – two separate days of taking time off work, driving on the interstate, and finding parking, could so easily have been avoided. Not to mention that the insurer could have saved money. To say nothing about time wasted by physician, imaging department and unnecessary increased exposure to radiation. This was a purely administrative issue, and flies in the face of several well established medical guidelines. 'primum non nocere' and eliminated any judgment factor on the part of the legaly respomsible provider.

Case3: Charity is fraud Provider Confusion

I spotted a mass in the kidney at the edge of the field of view, which looked like cancer, in an elderly man having a cardiac MRI.

“Let’s go lower and cover the kidneys, and the bladder,” I asked the technologist.

“I can’t. That’s fraud. Covering the kidneys will make this an MRI of the abdomen, which the patient doesn’t have a script for.” The technologist said.“Fraud! WTF,” I barked.

“It is Medicare fraud if you do more for the patient than what you’ve billed for,” explained the technologist. I was losing my marbles – but I wasn’t going to relent with this one.“Just do it – put my name down. Say I insisted. And if it’s fraud to do more than I billed for, I’ll happily go to Guantanamo Bay for fraud.”

The kidneys were covered. I overcalled the finding in the kidney – the patient did not have cancer. However, the technologist was correct – it can be considered fraud to dispense billable services (such as an MRI of the abdomen) to Medicare patients without billing Medicare. This reminds me of a physician I once met, who specializes in physical medicine and rehabilitation, and runs a direct pay practice. She doesn’t accept Medicare, Medicaid or any insurance. She sees kids of undocumented migrants for free one afternoon a week, but won’t extend the same courtesy (i.e. waiving charges) to patients on Medicaid because she fears she might be fried for fraud.

Charity is fraud with Medicare and Medicaid. Allow that to sink for a moment.I understand it is fraud if you buy a ticket from Philadelphia to New York and get off at Boston, but how is it fraud if you buy a ticket to Boston and get off at New York? Who makes these rules? Who are these people? Which parts of their brain light up on functional MRI? What do they eat for breakfast? How can a country which gave the world Edison, Wright brothers, and Kim Kardashian produce such imbeciles?

It is hard to maintain disdain for such buffoonery for too long because such spectacular incompetence is an art, a practiced art to be precise, but art nonetheless, and art induces wonder, eventually. But even this explanation is wrong. Third party payers are not incompetent.They may seem to be, but they’re not.

The reason insurers, and Medicare, would rather pay more, than less, for an exam, that is cut off their nose to spite their face, is that they don’t trust physicians. They don’t trust physicians because fifty years of health economics has yielded a spectacular insight – physicians, like crack dealers, are guilty of supplier-induced demand. This meme is now structurally embedded in payers.

The information to discern between physicians inducing their demand and physicians curbing their demand is too costly to obtain. So third party payers have a blanket rule – you can neither upgrade nor downgrade an imaging study, and if you do you’ll be paid nothing or will be done for fraud.

Don’t get me wrong – I’m flattered that I induce my demand in healthcare (I wish I could induce my demand in other areas, too). But a costly game of chicken is being played between payers and providers. It’s a game of reverse chicken actually, where both sides avoid staring at each other, and adapt to each other’s pathologies. The costs of this game may be forgivable but the inconvenience to patients is inexcusable.

The Bottom Line

There is an ever present tension between providers, hospitals, and insurance companies.

There are good reasons for this state of mind. Have you ever examined a bill from the emergency department and/or hospital visit or surgical procedure? This 'Alice in Wonderland' example truly astounds. Hospitals routinely send statements to the plans for tens of thousands of dollars and accept payments of less than 30% of the billed amount. Is this fraud? Technically, it is not since plans and hospitals negotiate contracts to lesser amounts. However if a patient is not insured they would receive a statement saying they owed the full amount. A heart stopper for the patient. This has been an ongoing situation since I began medical practice over 40 years ago, and it has become much worse. It becomes even worse if one attempts to examine why, the details of which are buried in bureaucratic mandates and rules regarding formulas for reimbursement, including the diagnostic related group, which reimburses based upon diagnosis rather than fee for services. Another set of payment reform in being added to the mix, that of value based payments,k which correlates the quality measures the hospital uses based upon an arbitrary metric created by 'health experts and committees which may have no real world value.

Disclaimer

The vignettes have been modified from their true state to protect patient health information and to protect the author from HIPAA vigilantes and bounty hunters. However, the gist of the vignettes is correct.

Friday, January 20, 2017

Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health. The department is influential in maintaining the nation’s health in four key areas:

Supporting Rural Medicine Among those efforts is the Distance Learning and Telemedicine Grants, which distributes millions of dollars to strengthen telecommunications in rural communities and increase access to resources such as teachers and doctors

Health Education

Since 1969, the Expanded Food and Nutrition Education Program has worked with low-income families to develop healthy diet and exercise habits and educate them about food safety.

Preventing Foodborne Illness Nationally And In Your HomeThe USDA helps protect the food supply through the Food Safety and Inspection Service.The office monitorsthe importation of meat, poultry and egg products by issuing safety certifications to some foods from other countries and auditing their food inspection systems.

Domestically, the same agency monitors food processing and distribution through microbiological testing. It also maintains a system that tracks and alerts potentially dangerous foods. For consumers, the office maintains a USDA Meat and Poultry Hotline to answer individual questions about food preparation.

Wednesday, January 18, 2017

— At today’s Senate health committee hearing on the nomination of Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services, Chairman Lamar Alexander (R-Tenn.) said that Obamacare should be repealed and replaced simultaneously and concurrently as President-elect Trump and Speaker Paul Ryan have also suggested.

“To me, ‘simultaneously’ and ‘concurrently’ means Obamacare should be finally repealed only when there are concrete, practical reforms in place that give Americans access to truly affordable health care. The American people deserve health care reform that’s done in the right way, for the right reasons, in the right amount of time. It’s not about developing a quick fix. It’s about working toward long-term solutions that work for everyone.”

During the hearing, Alexander addressed the collapsing Obamacare exchanges in Tennessee and across the country and detailed his three-part plan to repeal and replace Obamacare simultaneously and concurrently.

Alexander said Dr. Price was an excellent nominee and said he looked forward to working with him on rescuing Americans trapped in the failing Obamacare system and building better systems.

Alexander concluded: “Finally, when our reforms become concrete, practical alternatives, we will repeal the remaining parts of Obamacare in order to repair the damage it has caused Americans. This is what I believe we mean when we say Obamacare should be repealed and replaced, simultaneously and concurrently.”

While some criticize Dr. Price for some of his leanings, it is reassuring that a qualified physician/surgeon has been appointed as a cabinet member, one who truly understands what patients and providers need from organizations that regulate health care.

Tuesday, January 17, 2017

Not quite as 'sexy' is what the affordable care act is funding in regard to helping eliminate health care professional shortage. Adding 30 million uninsured to the ranks of 'insured' increases the shortfall in regard to provider access.

“The most critical step in connecting people to quality health care is a primary care provider,” says Secretary Burwell within a press release. “These awards provide financial support directly to health professionals, including physicians, registered nurses, and physician assistants, to help individuals – particularly the 17.6 million uninsured who have recently gained coverage – find the primary care services they need,” Burwell adds.

According to HHS, over 9,600 NHSC primary care medical, dental, nursing and behavioral and mental health practitioners provide “culturally competent care to millions of medically underserved people.” Over 2,000 NURSE Corps nurses are working to strengthen care access, the organization maintains. The bipartisan Medicare Access and CHIP Reauthorization Act, signed into law by President Barack Obama last April, allows for a two-year NHSC funding extension, explains HHS.

“These awards not only strengthen our primary health care workforce, but increase access to primary care in urban, rural and frontier locations nationwide,” adds Jim Macrae, Acting Administrator of the Health Resources and Services Administration (HRSA). “Collectively, these programs are serving millions of Americans who rely on the National Health Service Corps and NURSE Corps clinicians for essential health care services,” says Macrae.

A financial breakdown regarding the awards and the type of support they intend to offer is as follows:

National Health Service Corps Scholarship Program: 200 new awards at $39 million to provide students studying medicine, dentistry, or pursing education as a nurse-midwife, physician assistant, or nurse practitioner in exchange for the delivery of primary health care services in areas where need is “greatest”

National Health Service Corps Students to Service Loan Repayment Program: nearly 100 new awards at over $11 million to provide loan repayment assistance to allopathic and osteopathic medical students nearing graduation in return for their completion of a primary care residency and work within rural and urban areas of “greatest” need

NURSE Corps Scholarship Program: over 250 new awards at over $23 million granted to nursing students in exchange for a minimum two-year work agreement within a facility experiencing “critical shortages”

NURSE Corps Loan Repayment Program: over 600 awards at almost $40 million to offer nurses loan repayment assistance in exchange for a commitment to serve at least 2 years at a healthcare facility with a “critical” nurse shortage or as a faculty member at an accredited nursing school

Faculty Loan Repayment Program: over $1 million for 21 new awards to health professions educators in exchange for serving as a faculty member in an accredited, eligible health professions school

Regarding such awards, it is perhaps unclear at this time what primary emotional, financial, professional, educational, and personal challenges students and healthcare professionals will face working in areas where there are noted staffing shortages and dire “critical” need situations. It is hopeful the student completion and retention rate, for instance, will remain steady. Nursing faculty – as well as other STEM-based faculty members – are now facing “the most severe” shortages within entire educational institutions, in turn threatening the collective quality of the nursing workforce. Will awards such as these help the healthcare industry thrive? Perhaps large sums of money placed on the table for loan repayments and the like will mean only the strongest survive, at least with heavier wallets.

The United States Department of Health and Human Services (HHS) awarded over $240 million this week – including nearly $176 million in Affordable Care Act (ACA) funding – to strengthen primary healthcare accessibility. Confirms HHS Secretary, Sylvia M. Burwell, funding will support the National Health Service Corps (NHSC) and NURSE Corps scholarship and loan repayment programs.

Sunday, January 15, 2017

As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer's Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer's pathology such as the hippocampus.

Hippocampus, the brain's key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer's. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer's Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer's pathology such as the hippocampus.

All datawere obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healhty controls. Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls. The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., "As a physician who routinely sees marijuana users, what struck me was not only the global reduction in blood flow in the marijuana users brains , but that the hippocampus was the most affected region due to its role in memory and Alzheimer's disease. Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging. This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer's."

Dr. George Perry, editor in chief of the Journal of Alzheimer's Disease said, "Open use of marijuana, through legalization, will reveal the wide range of marijuana's benefits and threats to human health. This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage."

According to Daniel Amen, M.D., Founder of Amen Clinics, "Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion. In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order."

The age at which an adolescent begins using marijuana may affect typical brain development, according to researchers at the Center for BrainHealth at The University of Texas at Dallas. In a paper recently published in Developmental Cognitive Neuroscience, scientists describe how marijuana use, and the age at which use is initiated, may adversely alter brain structures that underlie higher order thinking.

Findings show study participants who began using marijuana at the age of 16 or younger demonstrated brain variations that indicate arrested brain development in the prefrontal cortex, the part of the brain responsible for judgment, reasoning and complex thinking. Individuals who started using marijuana after age 16 showed the opposite effect and demonstrated signs of accelerated brain aging.

"Science has shown us that changes in the brain occurring during adolescence are complex. Our findings suggest that the timing of cannabis use can result in very disparate patterns of effects," explained Francesca Filbey, Ph.D., principal investigator and Bert Moore Chair of Behavioral and Brain Sciences at the Center for BrainHealth. "Not only did age of use impact the brain changes but the amount of cannabis used also influenced the extent of altered brain maturation."

The research team analyzed MRI scans of 42 heavy marijuana users; twenty participants were categorized asearly onsetusers with a mean age of 13.18 and 22 were labeled as late onset users with a mean age of 16.9. According to self-reports, all participants, ages 21-50, began using marijuana during adolescence and continued throughout adulthood, using cannabis at least one time per week.

According to Filbey, in typical adolescent brain development, the brain prunes neurons, which results in reduced cortical thickness and greater gray and white matter contrast. Typical pruning also leads to increased gyrification, which is the addition of wrinkles or folds on the brain's surface. However, in this study, MRI results reveal that the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users. These three indexes indicate that when participants began using marijuana before age 16, the extent of brain alteration was directly proportionate to the number of weekly marijuana use in years and grams consumed. Contrastingly, those who began using marijuana after age 16 showed brain change that would normally manifest later in life: thinner cortical thickness, stronger gray and white matter contrast.

An article entitled "Comparison of Outcome Expectancies for Synthetic Cannabinoids and Botanical Marijuana," from The American Journal of Drug and Alcohol Abuse, studied the expected outcomes of both synthetic and natural marijuana.

186 adults who had previously used both synthetic and natural marijuana, as well as 181 who had previously used only botanical marijuana, were surveyed about their expected outcomes of using either type of cannabinoid. The results showed that the expected negative effects were significantly higher for synthetic marijuana than for natural marijuana across both categories of use history.

Despite the more commonly expected negative effects of synthetic cannabinoids, the most cited reasons for using these compounds were wider availability, avoiding a positive drug test, curiosity, perceived legality, and cost.

Authors concluded, "Given growing public acceptance of recreational and medical marijuana, coupled with negative perceptions and increasing regulation of synthetic cannabinoid compounds, botanical marijuana is likely to remain more available and more popular than synthetic cannabinoids.

The recent legalization of marijuana use in California and many other states inspired Health Train Express to publish a series of articles on the use of Marijuana.

Chronic marijuana use disrupts the brain's natural reward processes, according to researchers at the Center for BrainHealth at The University of Texas at Dallas.

In many ways this legalization follows the aftermath of 'prohibition' of alcohol many decades ago. History repeats itself. The course now set before us very much mirrors that of alcohol.

Caveat emptor ! Beware. Most of the same caveats apply to marijuana as they do to alcohol. Legalizing marijuana use is in no way any safer than using alcohol. Addiction and abuse are major dangers. Government now will tax sales in lieu of the cost of enforcment and the many lives that are imprisoned for minor infractions using marijuana in the past.

Scientific peer reviewed articles have been published in the past decade

This is the first of a number of article on legalization ofMarijuana.

Dependence alters the brain's response to pot paraphernalia

New research from The University of Texas at Dallas demonstrates that drug paraphernalia triggers the reward areas of the brain differently in dependent and non-dependent marijuana users.

The study, published July 1 in Drug and Alcohol Dependence, demonstrated that different areas of the brain activated when dependent and non-dependent users were exposed to drug-related cues.

The 2012 National Survey on Drug Use and Health shows marijuana is the most widely used illicit drug in the United States. According to a 2013 survey from the Pew Research Center, 48 percent of Americans ages 18 and older have tried marijuana. The National Institute on Drug Abuse states that 9 percent of daily users will become dependent on marijuana.

"We know that people have a hard time staying abstinent because seeing cues for the drug use triggers this intense desire to seek out the drugs," said Dr. Francesca Filbey, lead author of the study and professor at the Center for BrainHealth in the School of Behavioral and Brain Sciences. "That's a clinically validated phenomenon and behavioral studies have also shown this to be the case. What we didn't know was what was driving those effects in the brain."

To find this effect, Filbey and colleagues conducted brain-imaging scans, called functional magnetic resonance imaging (fMRI), on 71 participants who regularly used marijuana. Just more than half of those were classified as dependent users. While being scanned, the participants were given either a used marijuana pipe or a pencil of approximately the same size that they could see and feel.Marijuana has been shown to have some therapeutic effects

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.